MEDICARE: STANLEY WILLIAM MARKS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	25803	FL

General Provider Information

NPI Number	:	1457855793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY WILLIAM MARKS MD

Provider Business Mailing Address
First Line	:	3111 STIRLING RD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-6566
Country	:	US
Telephone Number	:	954-265-5936
Fax Number	:	954-265-7749

Provider Business Practice Location Address
First Line	:	3111 STIRLING RD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-6566
Country	:	US
Telephone Number	:	954-265-5936
Fax Number	:	954-265-7749

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	03/21/2018

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